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Clinical practice guidelines are "systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances."1 They are intended to offer concise instructions on how to provide healthcare services.2 The most important benefit of clinical practice guidelines is their potential to improve both the quality or process of care and patient outcomes.3 Increasingly, clinicians and clinical managers must choose from numerous, sometimes differing, and occasionally contradictory, guidelines.4 This situation is further complicated by concerns about the quality of available guidelines.5,6,7,8,9,10,11 Indeed, adoption of guidelines of questionable validity can lead to the use of ineffective interventions, inefficient use of scarce resources, and perhaps most importantly, harm to patients.12,13
Determining which guidelines are quality products worthy of adoption can be daunting. Every effort should be made to identify existing guidelines that have been rigorously developed and to adopt or adapt them for local use.12 However, organisations and clinicians should scrutinise the methods by which the guidelines were developed, as well as the content and utility of the recommendations. Even guidelines developed by prominent professional groups or government bodies should not be exempt from this scrutiny as it has been shown that these guidelines may be of substandard quality.10
The Practice Guidelines Evaluation and Adaptation Cycle14,15 is a framework for organising and making decisions about which high quality guidelines to adopt (figure). Although the cycle was originally intended for use by organisations and groups wanting to implement best practice, most steps of the process are also helpful in guiding evaluation of guidelines by individual clinicians. This Users' guide will describe strategies for identifying, critically appraising, and adopting or adapting guidelines for local use.
The first step is to select an area in which to promote best practice. Reasons for selecting a particular area can include the prevalence of the condition or its associated burden, concerns about large variations in practice or care gaps, costs associated with different practice options, the likelihood that a guideline will be effective in influencing practice, a desire to keep practice up to date or evidence-based, or awareness of the existence of relevant evidence-based guidelines.
When an organisation or group is interested in providing best practice, a local interdisciplinary guideline evaluation group should be established comprising key stakeholders who will be affected by the selection of guideline recommendations, including patients or individuals from the community.14 The advantages of using a group to evaluate guidelines include sharing of work among group members, reduced potential for bias in the evaluation process, and increased awareness of guidelines and opportunities for group members to develop ownership of the resulting decisions.
It is important to select an appraisal process. Guideline appraisal instruments are intended to be used to systematically assess and compare guidelines using the same criteria. They typically consist of a several quality criteria or items that assess the extent to which each guideline meets these criteria. To date, many appraisal instruments have been developed.16 The Appraisal of Guidelines Research and Evaluation (AGREE) Instrument (http://www.agreecollaboration.org)17 is rapidly becoming accepted as the gold standard for guideline appraisal. The AGREE instrument has been tested in 11 countries on >100 guidelines and >200 appraisers.17 It is endorsed by the World Health Organization, the Council of Europe, and the Guidelines International Network (http://www.g-i-n.net).
The AGREE instrument was designed to assess the process of guideline development and the extent to which the process is reported. It consists of 23 Likert scale items organised into 6 domains. Each domain is intended to capture a separate dimension of guideline quality (see box). Each guideline assessed is assigned standardised dimension scores ranging from 0–100. It also includes a question to provide a global assessment of the overall quality of the guideline, ie, whether one would "strongly recommend this guideline for use in practice without modifications," "recommend this guideline for use in practice on condition of some alterations or with provisos," or "not recommend this guideline (not suitable for use in practice)." Complete information about the instrument can be found at www.agreecollaboration.org.
Although some might want to view the results from this quantitative evaluation as an objective measure of guideline quality, it is important to remember that scores are influenced by the extent to which the guideline developers described the methods used to develop the guideline and reach consensus on the recommendations. A rigorously developed guideline may score poorly if the process was not well described.
Nurses caring for patients who had had a stroke wanted to provide best practice across the continuum of care in their community. A working group was formed, with nurses representing acute care, long term care, and rehabilitation settings. The group identified the first clinical priority for nursing care as the development of a consistent, evidence-based approach for risk assessment. Key areas were risk of falling, skin breakdown, and swallowing problems. In reviewing practices, they found that all settings had existing evidence-based policies for assessment of falls and pressure ulcers. Assessment of dysphagia, however, was an area of concern. The group invited a local speech and language pathologist and representatives from rehabilitation therapy and medicine to join the working group.
The working group decided to use a transparent and rigorous process to engage each of their settings and develop a solid foundation for future implementation of the risk assessment recommendations they would be developing. Given its reputation, they decided to use the AGREE instrument to evaluate guidelines that included risk assessment recommendations for patients with stroke.
AGREE quality criteria
Scope and purpose
1. The overall objective(s) of the guideline is (are) specifically described.
2. The clinical question(s) covered by the guideline is (are) specifically described.
3. The patients to whom the guideline is meant to apply are specifically described.
Stakeholder involvement
4. The guideline development group includes individuals from all the relevant professional groups.
5. The patients' views and preferences have been sought.
6. The target users of the guideline are clearly defined.
7. The guideline has been piloted among target users.
Rigour of development
8. Systematic methods were used to search for evidence.
9. The criteria for selecting the evidence are clearly described.
10. The methods used for formulating the recommendations are clearly described.
11. The health benefits, side effects, and risks have been considered in formulating the recommendations.
12. There is an explicit link between the recommendations and the supporting evidence.
13. The guideline has been externally reviewed by an expert panel prior to publication.
14. A procedure for updating the guideline is provided.
Clarity and presentation
15. The recommendations are specific and unambiguous.
16. The different options for management of the condition are clearly presented.
17. Key recommendations are easily identifiable.
18. The guideline is supported with tools for application.
19. The potential organisational barriers in applying the guideline have been discussed.
20. The potential cost implications of applying the recommendations have been considered.
21. The guideline presents key review criteria for monitoring and/nor audit purposes.
Editorial independence
22. The guideline is editorially independent from the funding body.
23. Conflicts of interest of guideline development members have been recorded.
The next step is to clarify the issues of particular interest. The PICO approach involves considering the Population, Intervention, Control or context, and Outcomes of interest.18,19 Based on the identified areas of interest, criteria for searching for and selecting guidelines for review are identified. Such criteria may include language of publication (eg, English only) or date of publication (eg, within the past 5 y). One study suggests that some recommendations included in well developed guidelines (eg, those produced by the US Agency for Healthcare Research and Quality) may become outdated within 3–4 years of release.20 The same study, however, noted that wound care guidelines were still current up to 7 years after their release. Although the language and year of publication can be used to limit the search for guidelines, other criteria can only be applied once potentially relevant guidelines have been retrieved. For example, a group may only be interested in guidelines based on high quality scientific literature and therefore exclude consensus documents; or they may include only guidelines developed by credible professional organisations and exclude those developed by one person. Regardless, the criteria should be determined before starting the search.
To ensure that high quality guidelines are not inadvertently missed, a systematic search for all relevant guidelines on the topic should be done. Guidelines can be identified using a few simple strategies. Check the US National Guideline Clearinghouse (http://www.guideline.gov), sponsored by the US Agency for Health Care Research and Quality. Another guideline repository is the Guidelines International Network (G-I-N) (http://www.g-i-n.net). G-I-N is an international not-for-profit association of organisations and individuals involved in clinical practice guidelines. Although G-I-N membership is required to access guidelines compiled by the network, non-members can access the websites of some of the guideline developers. Another efficient strategy is to search the websites of known guideline developers (eg, Scottish Intercollegiate Guidelines Network or Royal College of Nurses). To be thorough, it is also important to search the National Library of Medicine, which can be done for free using PubMed (http://www.ncbi.nlm.nih.gov/pubmed). Search terms known as MeSH (Medical Subject Headings) and text words that can be used are practice guideline, practice guidelines, clinical practice guideline, clinical practice guidelines, standards, consensus statement, and consensus.10 "Practice guidelines" can also be used as a publication type (pt) in searching.12
Increasingly, guideline developers are posting their guidelines directly on the web. This avoids delays in publication of guidelines by journals, permits rapid updating of guidelines, and reduces dissemination costs. When guidelines are posted directly to the web, there is a greater chance that they may not be indexed in commonly consulted bibliographic databases such as Medline. For this reason, it is prudent to also search the internet using a search engine such as Google (http://www.google.com). One should not assume that guidelines found on the internet are poor quality or that those indexed in Medline are necessarily high quality. All guidelines that meet the inclusion criteria should be retrieved. Because the appraisal process is based on information reported by guideline developers, all relevant documents related to the development process should be retrieved. In some cases, the published guideline will have minimal information about the development process because this information is presented elsewhere, perhaps in a technical report. Efforts should be made to obtain such supplemental documents.
The working group began by identifying guidelines they were familiar with and those currently used in their settings and scanned the bibliographies to identify additional guidelines. They decided to restrict the search to guidelines published in English or French as the group did not have the capability of reviewing documents in other languages and to restrict the search to documents published since 1997. The group then enlisted the help of a local hospital librarian, who worked with them to develop a search strategy to identify general guidelines about care of patients with stroke, with the expectation that some of these guidelines might include recommendations about dysphagia. They also decided to search specifically for guidelines about dysphagia. The databases searched were Medline, EMBASE/Excerpta Medica, CINAHL, and the US National Guideline Clearinghouse database. Websites of known guideline developers were accessed, and a Google internet search was done. The following topic related key words were used alone and in combination to identify general stroke guidelines: cerebrovascular accident, cerebrovascular disorders, stroke, rehabilitation, spasticity, electromyography, gait, assistive devices and equilibrium. The search for guidelines on assessment of dysphagia included all guidelines for the elderly and was not limited to the stroke population. Key words included risk, dysphagia, swallow disorders, and deglutition disorder.
All guidelines identified by the search strategy were retrieved and assessed based on the following predefined criteria : (1) produced by a group or organization (ie, not authored by one person); (2) included a bibliography; and (3) made recommendations for bedside swallowing assessment/screening targeted at clinicians such as nurses, speech-language therapists, general practitioners, physiotherapists, or occupational therapists.
Six guidelines included recommendations for the bedside assessment of dysphagia and were considered appropriate for appraisal using the AGREE instrument. 21– ,26
Determining whether a guideline is valid involves 3 separate but related steps: appraising the quality of the guideline as a whole, determining the currency of the guideline (ie, are the recommendations up to date?), and assessing the content of the recommendations.
a. Assess the quality of the guideline as a whole
Ideally, the AGREE instrument should be applied to all guidelines meeting the minimum inclusion criteria. However, this may not be practical or possible depending on the number of guidelines identified, the number of individuals who can participate in the appraisal, and time constraints. One strategy for quickly identifying the higher quality, evidence-based guidelines is to first screen the guidelines using the AGREE's "rigour of development" domain. The 7 items comprising this domain specifically focus on the degree to which the guideline development process was evidence-based and how evidence/research was incorporated into the recommendations. No universal agreement exists about specific cut off scores to identify high quality guidelines. Some domains (eg, rigour of development) may be considered more important than others and thus have a higher benchmark. The group should identify the range of acceptable quality scores (eg, ⩾70/100) and whether different domains should have different cut offs. Guidelines meeting the benchmark for the "rigour of development" domain can then be assessed using the other AGREE domains. Those scoring below the cut off can be excluded at this point. Regardless, the developers of the AGREE instrument suggest that ⩾4 appraisers should be used to ensure adequate inter-rater reliability.
b. Determine the currency of the guideline
Guidelines that meet minimum quality criteria must then be assessed to determine whether they are still current. Methods of checking the currency of guidelines include reviewing the date of release/publication; scanning the bibliography for the dates of the original studies cited; and checking with developers about whether they still consider the guideline to be current or have plans to update it. A quick Medline search for systematic reviews published since the release of the guideline may also be useful. Other sources of high quality systematic reviews include the Cochrane Database of Systematic Reviews and the Cochrane Controlled Trials Register (http://www.cochrane.org), the NHS Database of Abstracts of Reviews of Effectiveness (DARE) (http:/nhscrd.york.ac.ek/darehp.htm), and the York Centre for Reviews and Dissemination (www.york.ac.uk/inst/crd).27 "Netting the Evidence" (www.shef.ac.uk/uni/academic/R-Z/scharr/ir/netting.html) and the Joanna Briggs Institute (www.joannabriggs.edu) are useful for locating databases of evidence.
Six group members appraised each guideline using the AGREE instrument. The results of the quality appraisal process revealed some unexpected findings. Quality scores for rigour of development varied considerably, ranging from 16–82%. The 2 guidelines with the lowest quality scores on this dimension were from regional organisations well known to the working group members. For these reasons, the group decided to not exclude these 2 guidelines at this stage despite their poor quality scores. Scores on the domain of scope and purpose were more consistent and exceeded 60% for all guidelines. Scores on stakeholder involvement ranged from 33–90%. The lower scores on this dimension largely reflected the lack of inclusion of patient views and not piloting the guidelines. Scores on clarity and presentation, applicability, and editorial dependence were also variable. Examination of the global assessment by the appraisers revealed that no guideline was rejected by a majority of working group members. Three guidelines were strongly recommended "as is" by two thirds of the appraisers. More than half rated the other 3 guidelines as being "in need of modifications" or were unsure about whether to recommend them for use. All guidelines were produced since December 2000, suggesting that their recommendations were fairly current. The librarian also did a literature search for meta-analyses, reviews, and primary studies on the assessment of dysphagia that could be used as supplementary material.
c. Systematically assess the clinical content of guideline recommendations
Guideline appraisal instruments provide little detailed information on the actual recommendations being advanced in specific guidelines. Thus, if ⩾1 guideline is being considered, the next step is to conduct a "content analysis" of the recommendations in each guideline. It is useful to have 1 or 2 clinicians experienced in the content area produce a table comparing each guideline in terms of the specific recommendations made and the level of evidence supporting each recommendation (if such information is provided). Such a table, or recommendations matrix,14 can be the focus of the group's discussion or an individual clinician's deliberations about the content of the recommendations from each guideline. The recommendations matrix facilitates identification of similar recommendations in different guidelines, as well as differences in recommendations between guidelines. The matrix also facilitates easy identification of recommendations supported by strong evidence. Often, guidelines include several recommendations supported by evidence of differing strengths. When this happens, a group may decide to select recommendations supported by the best evidence from the guidelines under consideration. The recommendations matrix also provides a basis for considering the clinical usefulness of the recommendations and provides useful information to address the question of whether the recommendations will help in caring for patients in the relevant settings.
To facilitate comparison of the recommendations among the 6 guidelines, a nurse and the speech-language pathologist created a recommendations matrix that included the level of evidence supporting each recommendation.
At this point, the group must decide whether it will adopt one of the guidelines "as is" or adapt ⩾1 of the guidelines (ie, select some, but not all, recommendations from different guidelines). The recommendations must be considered in terms of whether they will be helpful for caring for patients and whether they are appropriate and feasible to implement in the specific practice setting(s) (eg, resources available to purchase special equipment needed to comply with guideline recommendation).
The choices at this step are to adopt or adapt existing guidelines. Adopting a guideline involves choosing the best guideline and accepting all recommendations as written. This may not be practical or feasible for many reasons, and the group may need to adapt or tailor ⩾1 guideline to their needs. Selection of this option may be appropriate if the recommendations are not a good fit with the practice setting (eg, some recommendations may not apply to the types of patients seen in the setting, or a practice group may be only willing to accept recommendations supported by strong evidence). As well, implementation issues, such as contextual factors or logistical or resource considerations, can make implementation of the recommendations impractical. Guideline adaptation essentially involves taking the best or most appropriate recommendations and repackaging them into a new local guideline.
Guideline developers are always concerned that local adaptation of guidelines will result in modifications to recommendations that ignore the evidence. Local adaptation of existing guidelines should never involve changing evidence-based recommendations unless the supporting evidence has changed since release of the guideline. If recommendations are modified in any way, the rationale for changes should be explicitly stated in the resulting local guideline document. The group may also want to reconsider evidence that was located when conducting the search for systematic reviews as it could influence which recommendations are adapted.
After reviewing the recommendations and supporting evidence, the working group decided it would produce its own set of recommendations by adapting recommendations from existing guidelines. In some cases, the wording of existing recommendations was modified slightly to make them clearer. Caution was used when rewording recommendations to ensure that the intent of the original recommendation was not altered. The local guideline recommendations for dysphagia risk assessment were as follows:
1. All patients should be kept NPO until their swallowing has been screened using a simple valid bedside testing protocol (adapted from Department of Veterans Affairs/Department of Defense,21 Level B; Royal College of Physicians,22Level B).
2. The gag reflex alone is a poor predictor of swallowing function and should not be used for screening for dysphagia in stroke patients (Scottish Intercollegiate Guidelines Network–Dysphagia, 24 Level B).
3. Patients should be reviewed for dysphagia at least once a week after the initial assessment (adapted from Scottish Intercollegiate Guidelines Network–Dysphagia, 24 Level B).
The working group also decided to review the literature to identify a suitable valid bedside dysphagia testing protocol.
When the guideline evaluation process is undertaken on behalf of a group, the resulting draft of local recommendations should be sent to local practitioners, other stakeholders, and organisational policy makers for review and comment. This step should be done even if a single guideline is adopted in its entirety. Seeking feedback on the proposed guideline ensures that those intended to use the guideline have an opportunity to review the document and identify potential difficulties for implementation before the guideline is finalised. This step allows policy makers to consider the organisational effects of implementing the recommendations and to begin preparing for its future adoption. It also serves as the first wave of dissemination of the guideline and provides the group with an opportunity to address the issues raised by reviewers before finalising the local guideline.
Depending on the extensiveness of the adaptation process, it may also be reasonable to send the local guideline to external experts for review of its content validity, clarity, and applicability. This can help to ensure that recommendations from existing guidelines have not been taken out of context or adapted inappropriately.
The group should consider all feedback and, if necessary, modify the local guideline recommendations to address the concerns. All changes made should be documented in the local guideline as well as reasons for not making suggested changes. Being explicit and transparent about the process should increase the credibility of the process among potential guideline users. Once finalised, official endorsement of the guideline should be sought from policy makers in settings where the guideline is intended to be implemented. This step involves review of the proposed guideline (which may have been modified based on feedback) by the organisation and formal adoption, with official status. This is done, for example, when an organisation endorses a guideline as policy. This administrative step provides the organisation with a final opportunity to consider the effects of the proposed guideline on its functioning. The formal decision making and procedural process required to endorse a guideline needs to be explicit and documented by the organisation. Once the organisation provides its "seal of approval," the guideline is ready for dissemination and implementation. If plans for dissemination and implementation of recommendations have not been considered, they should be at this point.
The group should develop a plan for when and how the local guideline will be reviewed and updated (which will obviously depend on when the original guidelines expire) or provide a guideline expiry date. Other criteria for determining when a guideline needs updating include changes in evidence on existing benefits or harms associated with recommendations, important outcomes, available interventions, evidence that current practice is optimal, values placed on outcomes, and resources available for health care.27
Depending on the extent of the changes to recommendations required by new evidence, the guideline evaluation group may want to simply seek practitioner or policy maker feedback on the changes, or begin the entire guideline evaluation cycle over again. In any case, plans for reviewing and revising the guideline should be documented. Individual clinicians who make decisions about which guidelines or specific recommendations they will personally follow must also be aware of the currency of the guidelines and any new guidelines or evidence which may be more current.
The local guideline document was sent to the practice committees or councils in each of the involved settings for review and feedback. The working group reviewed the feedback from all sources. The feedback revealed that front line nurses were positive about assessing patients for dysphagia but needed training and time to develop confidence in their assessment skills. The local guideline was finalised and sent to the regional stroke team as well as the heads of programmes in each setting for official endorsement and adoption. Working with clinical managers, the working group developed a strategy to plan for staff education, phase-in the recommendations, and enhance current documentation processes to capture dysphagia assessment. The working group, managers, and librarian also developed a strategy for periodically reviewing the literature for new guidelines on the topic or updates of existing guidelines in order to keep the local guideline current.
Practice guidelines have the potential to improve process of care as well as patient outcomes. However, their beneficial effects are contingent on successful implementation. Clinical settings can move towards explicit use of evidence in practice by adopting existing guidelines or by local adaptation of existing guidelines. Careful consideration of available guidelines using the process described above can inform clinical and programme level decision making about which guidelines or recommendations are most suitable for their setting. Use of a rigorous and transparent process for identifying, appraising, and adopting/adapting guidelines is crucial as practice guidelines are essentially multiple interventions and the decisions made affect both patients and providers.


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I want to get the UserId, Value for the max(Date) for each UserId. That is, the Value for each UserId that has the latest date. Is there a way to do this simply in SQL? (Preferably Oracle)
Update: Apologies for any ambiguity: I need to get ALL the UserIds. But for each UserId, only that row where that user has the latest date.

subset: commoncrawl


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Facebook: Soundgarden Fans have been anxiously awaiting a new album from Soundgarden for more than 15 years, and the Nov. 13 arrival of 'King Animal' is just a couple weeks away. A deluxe edition of the release will also be available at Best Buy that includes extra tracks. In addition to the 13 songs on 'King Animal,' demo versions of the songs 'Black Saturday,' 'Bones of Birds,' 'By Crooked Steps,' 'A Thousand Days Before' and 'Worse Dreams' will also be included. Finished versions of all five songs also appear on the album. 'Been Away Too Long' is the first single from 'King Animal.' Frontman Chris Cornell describes the song as "a look back at history in sort of a strange atmospheric way." Cornell called the song's lyrical narrative a way of saying, "We've been gone for 15 years and now we're back. It's about time, and we still have something to say about rock music that no one else is saying — and I feel confident about saying that." So why did the band split up back in 1997? Cornell says , "We broke up because we were bored of the periphery, all of the things that are outside of the band playing music and writing songs, playing shows – that part got really boring." Bassist Ben Shepherd adds, "The part that is outside of writing songs and playing shows. So it wasn't the Soundgarden thing, it was the outside of Soundgarden." Soundgarden will play the British TV show 'Later With Jools Holland' on Nov. 6. According to Grunge Report , they've also just booked a 'Live on Letterman' mini concert following their Nov. 12 appearance on the 'Late Show With David Letterman,' and they have two European concerts scheduled on Nov. 7 (Dortmond, Germany) and Nov. 9 (London, England). [button href="http://loudwire.com/best-soundgarden-songs/" title="Next: 10 Best Soundgarden Songs" align="center"]
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Soundgarden's 'King Animal' Best Buy Edition Bolstered With Bonus Tracks


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11. Hungering and Thirsting after Righteousness (Matthew 5:6)
Related MediaIntroduction
Blessed are those who hunger and thirst for righteousness, for they shall be filled (Matthew 5:6).154
We begin our study of this great beatitude with a quote from Martyn Lloyd-Jones:
This Beatitude again follows logically from the previous ones; it is a statement to which all the others lead. It is the logical conclusion to which they come, and it is something for which we should all be profoundly thankful and grateful to God. I do not know of a better test that anyone can apply to himself or herself in this whole matter of the Christian profession than a verse like this. If this verse is to you one of the most blessed statements of the whole of Scripture, you can be quite certain you are a Christian. If it is not, then you had better examine the foundations again.155
This one short verse of Scripture brings to us an incredible message of hope, and a message that should spark a deep sense of joy in all of us who are believers and those who may be seeking Christ. Satisfaction is available, but only through Christ.
In one sense, we can all relate to this passage of Scripture – we all hunger. We may not be able to know the depth of hunger the people of this time were going through, but we experience a daily hunger that comes back and needs to be satisfied. I can remember times in my life where I longed for certain foods and hungered and thirsted to a great degree. I remember times in other countries such as Indonesia where I went on a six-day trek through the jungles of Irian Jaya. All we had to eat was bland Indo-Mi, which is a type of ramen noodle; after six days of that, I had many visions of hamburgers and steak and other such foods. I literally longed and hungered for those foods. On our way back from Russia two summers ago, our missions team had a 24-hour layover in Seoul, Korea; we asked the students with us what they wanted to eat for lunch, assuming they might want to try some authentic Korean food. But they insisted on having McDonald's or Baskin-Robbins because they had not had American food in six whole weeks. They were tired of eating things they were not used to, and they hungered after things they had not had in a while. We can all relate to this concept of hunger; that is why this is such a great illustration that Jesus uses here in the Sermon on the Mount.
Let's read this verse in the context of Matthew 5:1-12.
And seeing the multitudes, He went up on a mountain, and when He was seated His disciples came to Him. Then He opened His mouth and taught them, saying:
"Blessed are the poor in spirit,
For theirs is the kingdom of heaven.
Blessed are those who mourn,
For they shall be comforted.
Blessed are the meek,
For they shall inherit the earth.
Blessed are those who hunger and thirst for righteousness,
For they shall be filled.
Blessed are the merciful,
For they shall obtain mercy.
Blessed are the pure in heart,
For they shall see God.
Blessed are the peacemakers,
For they shall be called sons of God.
Blessed are those who are persecuted for righteousness' sake,
For theirs is the kingdom of heaven.
"Blessed are you when they revile and persecute you, and say all kinds of evil against you falsely for My sake. Rejoice and be exceedingly glad, for great is your reward in heaven, for so they persecuted the prophets who were before you" (Matthew 5:1-12).
Evangelistic Message of Hope!
Why is hungering and thirsting such a good illustration? Because as water and food is to the body, so righteousness is to the spiritual life. We as humans hunger and thirst not only for food but for satisfaction in life. We search in all kinds of different areas to be filled, to be satisfied, but we always end up falling short.
He has made everything beautiful in its time. Also He has put eternity in their hearts, except that no one can find out the work that God does from beginning to end (Ecclesiastes 3:11).
John Piper states: "God has put eternity in our hearts and we have an inconsolable longing."156 Blaise Pascal said that we all have a "God-shaped void" in our lives. All men are hungry and thirsty; the problem is that we try to fill that emptiness, that hunger, with things other than the righteousness of God. Some of you reading this message are empty; you have not been satisfied. You are trying to fill that "God-shaped void" in your life with all kinds of things, but you are left empty, unsatisfied. There is an incredible message of hope for you if you are searching for the answer.
Ho! Everyone who thirsts, come to the waters; and you who have no money, come, buy and eat. Yes come, buy wine and milk without money and without price. Why do you spend money for what is not bread, and your wages for what does not satisfy? Listen carefully to Me, and eat what is good, and let your soul delight itself in abundance (Isaiah 55:1-2).
Has a nation changed its gods, which are not gods? But my people have changed their glory for what does not profit. Be astonished, O heavens, at this, and be horribly afraid; Be very desolate, says the Lord. For My people have committed two evils. They have forsaken Me, the fountain of living waters, and hewn for themselves cisterns – broken cisterns that can hold no water (Jeremiah 2:11- 13).
These two sets of verses are very powerful. We are spending our money on things that do not satisfy; we are drinking from cisterns that can hold no water. Our satisfaction is not being met in the things of this world. We try to satisfy ourselves with money and power, education, sex, pornography, boyfriends and girlfriends, toys and earthly possessions that allow us fun and entertainment for a time, but yet all these things lead to a deeper sense of need, a deeper longing for satisfaction, because they do not fill that need. C.S. Lewis states:
We are half hearted creatures, fooling around with drink and sex and ambition, when infinite joy is offered us, like an ignorant child who wants to go on making mud pies in a slum because he cannot imagine what is meant by the offer of a holiday at the sea, we are far too easily pleased.157
What a powerful quote by C.S. Lewis! We as human beings are far too easily pleased. We fool around with so many things that do not satisfy, things that do not, and cannot, fill that void and emptiness, all because we are far too easily pleased. We think so often that the things of this world will satisfy, when we always end up falling short of what we desire, and a lot of it is because we are not seeking the right things. The joy that is offered to us, the peace that is offered to us, the satisfaction that is offered to us, is unbelievable if we would only grab hold of Jesus and His offer to be our satisfaction.
A great illustration of this is the story of the prodigal son in Luke 15:11-32. He took the inheritance his father had given him, left home, and went to a far-off country where he squandered his inheritance money on riotous living, on things that would not satisfy. He was far too easily pleased and fooled into thinking that this was what life was all about, only to fall short. When he had a lot of money, he had a lot of friends and parties. But when the money was gone, so were his friends. At this point in time, he begins to "go down hill" in a major way, to the point of living with pigs and eating the slop they ate. Martyn Lloyd-Jones quotes J.N. Darby:
To be hungry is not enough; I must be really starving to know what is in His heart towards me. When the prodigal son was hungry he went to feed upon husks, but when he was starving, he turned to his father.158
In Matthew 5:6, Jesus is not just talking about mere hunger, but about starving after righteousness.
Picture the audience listening to Jesus. They were Galileans, not well liked by the rest of the Jewish community; they were lower class citizens; they were viewed similarly to the way the Jews looked at the Samaritans. Weeks ago, you may recall Bob Deffinbaugh's reference in his lesson in this series to what he calls the "I.P.," the "Inversion Principle." 159 I challenge you to take a look at his notes on this subject to see who exactly the Galileans were.
Looking at the crowd surrounding Jesus, what do you think their view of righteousness was? I can guarantee you their view of righteousness was a skewed view, a wrong view, due to the portrayal of righteousness by the religious leaders. When reading and studying Matthew 5:6, you must look over to Matthew 5:20 to see the connection Jesus is making. The view these people had of righteousness was an incorrect view; Jesus was correcting that view and showing them that it was an issue of the heart.
For I say to you, that unless your righteousness exceeds the righteousness of the Pharisees, you will by no means enter the kingdom of heaven (Matthew 5:20).
I can see this as being the picture of righteousness the audience has, a picture of the religious leaders who are outwardly righteous and pious but inwardly sinful, corrupt men. They look and see the judgmental attitude of the Pharisees, the hypocritical nature of these men. They may in some way look good on the outside, but inwardly they are missing the point of doing the things they are doing. The Pharisees are feeling as though by their actions they are gaining righteousness and doing right in the eyes of God. Here in this passage Jesus is lengthening the distance between God and man and addressing the self-righteousness of the Pharisees, as well as the issue of the heart of the people in the crowd. Here Jesus is raising the bar and addressing the issues of the heart. Jesus is presenting to the crowd that He is that true Righteousness; He is the One they have been hungering and thirsting after, and the only One who can fill that emptiness inside them. He is saying He is the good news, the gospel. The gospel has come, and it has come in Him. He is presenting Himself as the means to satisfaction.
If we look at other passages, we see Him making this same point. Jesus is the only way to righteousness, and His righteousness satisfies.
The Woman at the Well - Jesus answered and said unto her, whoever drinks of this water will thirst again, but whoever drinks of the water that I shall give him will never thirst. But the water that I shall give him will become in him a fountain of water springing up into everlasting life (John 14:13-14).
Feeding the 5000 – Jesus answered them and said, most assuredly, I say to you, you seek Me, not because you saw the signs, but because you ate of the loaves and were filled. Do not labor for the food which perishes, but for the food which endures to everlasting life, which the Son of Man will give you, because God the Father has set His seal on Him (John 6:26-27).
Jesus Christ is the only one who can satisfy, and here in this verse in Matthew, He is presenting this point to the audience before Him. To some, this message brings refreshment because they see the Pharisees and the self-righteousness of the Pharisees and are "turned off;" now they are given a new perspective in Christ, an offer of satisfaction through Him, the true Righteousness. Others in the audience are radically "turned off;" I am sure there were religious leaders in the crowd who were angered and bothered because they were being told they could not achieve favor with God through the law and through their own righteousness. God's favor could only be met in Christ's righteousness.
This truly is a message of hope to those who are lost and perishing, to those in Jesus' day and in our day. The emptiness that fills their lives, and ours, can only be satisfied in Christ, the true Righteousness. Only by hungering and thirsting after Christ can that void, that emptiness, be filled. The things of this world will not satisfy; only Jesus Christ satisfies. This is the message, then and now, to those who do not already have a relationship with Jesus, a message of hope. So why keep "messing around" with things that will only cause more pain and emptiness? An offer of joy, peace, and satisfaction among many other things is made to you in Christ – and in Christ alone.
To Believers
This message is one of hope to unbelievers, but what is this saying to believers? I truly believe there is a big, important message to us as believers. The first question is simple: In your life right now, what are you hungering and thirsting after? Where is your heart? In one sense, it is easy for us as believers to see that we are filled and satisfied when we accept the free gift of salvation, but too often that is where hungering and thirsting stops. Many believers struggle with big areas of sin, and they try to fill a hole with something other than Jesus Christ. Many pastors have fallen to the tragedy of pornography; many families have been destroyed through not hungering and thirsting after righteousness only to end up in divorce. Some of us sit week after week in the pews at church longing for a day in and day out satisfaction. Do we as believers hunger and thirst after righteousness?
Hungering and thirsting is continual. Every day I get hungry; around 11:00 a.m. or sometimes earlier, my stomach starts to growl, and I feel like I am going to digest myself if I don't get food. This is a daily pattern we go through, each one of us, because our body needs food; it is the same with thirst. This is the same in the spiritual realm of life. We need to hunger and thirst, actually starve, for righteousness in our lives; it is a day-by-day thing that is a continual part of our lives. It is like going to a nice steak restaurant and eating a big steak and baked potato or French fries with a side salad. You eat dinner and are full that night, but you long for the same meal again the next day, and the next. With righteousness, once we get a taste of it and hunger for it, that hunger for righteousness grows, and we should want to keep feeding that desire to satisfy our lives with righteousness. We are called to holy living as believers. We are called to live lives of holiness to our God, which is a sweet smelling aroma to Him.
Let's look at a couple of Old Testament examples of those who hungered after righteousness.
Psalm 63:1-11
O God, You are my God;
Early will I seek You;
My soul thirsts for You;
My flesh longs for You
In a dry and thirsty land
Where there is no water.
So I have looked for You in the sanctuary,
To see Your power and Your glory.
Because Your loving-kindness is better than life,
My lips shall praise You.
Thus I will bless You while I live;
I will lift up my hands in Your name.
My soul shall be satisfied as with marrow and fatness,
And my mouth shall praise You with joyful lips.
When I remember You on my bed,
I meditate on You in the night watches.
Because You have been my help,
Therefore in the shadow of Your wings I will rejoice.
My soul follows close behind You;
Your right hand upholds me.
But those who seek my life, to destroy it,
Shall go into the lower parts of the earth.
They shall fall by the sword;
They shall be a portion for jackals.
But the king shall rejoice in God;
Everyone who swears by Him shall glory;
But the mouth of those who speak lies shall be stopped.
Psalm 42:1-11
As the deer pants for the water brooks,
So pants my soul for You, O God.
My soul thirsts for God, for the living God
When shall I come and appear before God?
My tears have been my food day and night,
While they continually say to me,
"Where is your God?"
When I remember these things,
I pour out my soul within me
For I used to go with the multitude;
I went with them to the house of God,
With the voice of joy and praise,
With a multitude that kept a pilgrim feast.
Why are you cast down, O my soul?
And why are you disquieted within me?
Hope in God, for I shall yet praise Him
For the help of His countenance.
O my God, my soul is cast down within me;
Therefore I will remember You from the land of the Jordan,
And from the heights of Hermon,
From the Hill Mizar.
Deep calls unto deep at the noise of Your waterfalls;
All Your waves and billows have gone over me.
The LORD will command His lovingkindness in the daytime,
And in the night His song shall be with me—
A prayer to the God of my life.
I will say to God my Rock,
"Why have You forgotten me?
Why do I go mourning because of the oppression of the enemy?"
As with a breaking of my bones,
My enemies reproach me,
While they say to me all day long,
"Where is your God?"
Why are you cast down, O my soul?
And why are you disquieted within me?
Hope in God;
For I shall yet praise Him,
The help of my countenance and my God.
In these passages, the psalmist exemplifies what it means to long for and hunger and thirst for righteousness. "Early will I seek You; My soul thirsts for You; My flesh longs for You." "As the deer pants for the water brooks, so pants my soul for You, O God." Do you have this longing, this passion, this deep sense of need for hungering and thirsting after righteousness? Is this something you cannot live without? I tell you that this is what we as believers ought to be hungering after. We need to hunger after God on a daily basis, every second of every day. Hungering and thirsting need to be vital parts of our lives, such that we cannot live without satisfying that hunger and thirst. So many things that we do we think will not affect our relationship with Christ, but they do. Why do we find enjoyment as believers in going to movies that are geared toward and based upon adultery, divorce, violence, cursing the Lord's name, mockery, the degrading of human life? Why do we put into our minds those images, those lyrics to songs, those television shows that are based upon trickery and lies? These things hinder our walk with the Lord; they distract us from true righteousness. Hungering and thirsting after righteousness is not easy; in fact, in a lot of ways it is extremely difficult, because we have to make the tough decision, the decisions to be different, to not always do what other people are doing, to be willing as Daniel was to stand alone in the midst of our peers both old and young. There is no doubt that we in our lifetimes will always battle against the flesh and against sin, but as the writer of Hebrews states in 12:3-4:
For consider Him who endured such hostility from sinners against Himself, lest you become weary and discouraged in your souls. You have not yet resisted to bloodshed, striving against sin.
This does not mean that we take ourselves out of the world – it means that we live in the world, and that we live righteous lives amongst our co-workers, friends, peers, and enemies whose lives may not be characterized by righteousness. It means that we are that salt and light who show the love of Christ both through our actions and through our words. Is this a passion of your life? The men who wrote these psalms truly had a passion for Christ and that is what captivated their lives, that is what they longed for, because He is the only thing that satisfied.
In the New Testament, the Apostle Paul exemplifies this in Philippians 3:1-21, as we see in verses 8-12 of this passage:
Yet indeed I also count all things loss for the excellence of the knowledge of Christ Jesus my Lord, for whom I have suffered the loss of all things, and count them as rubbish, that I may gain Christ and be found in Him, not having my own righteousness, which is from the law, but that which is through faith in Christ, the righteousness which is from God by faith; that I may know Him and the power of His resurrection, and the fellowship of His sufferings, being conformed to His death, if, by any means, I may attain to the resurrection from the dead. Not that I have already attained, or am already perfected; but I press on, that I may lay hold of that for which Christ Jesus has also laid hold of me.
Here the Apostle Paul is showing that it is: (a) not a righteousness of His own, but of faith in Jesus Christ, and (b) that he is pressing on to lay hold of that which Christ has laid hold of him. He lays all the cares of the world aside and strives after righteousness in His walk with the Lord. He desires above all else to know Christ and the power of His resurrection. Do we count the things of this world as rubbish that we may know Christ? Are we striving to live lives that are godly and righteous? We are not talking here about the outward appearance of righteousness, but about the heart. What things does your heart long after? For what things does your heart hunger? Lord willing, it is as Paul says, "that I may know Him and the power of His resurrection" (Philippians 3:10).
Matthew 5:6 is a powerful passage, a passage that exudes hope all through it. "Blessed are those who hunger and thirst after righteousness for they shall be filled." We are blessed if we hunger and thirst after righteousness. How? Because we are filled; we don't hunger any longer as the world hungers because our satisfaction has been met in Christ. Hungering and thirsting after righteousness has both an evangelistic message for those who do not know Christ, as well as a message to those who are in Christ. I conclude with a simple question: What are you hungering and thirsting after in your life? I pray that all of us can answer, "Righteousness."
153 This is the edited manuscript of Lesson 13 in the Studies in the Gospel of Matthew series prepared by Lenny Correll on May 18, 2003.
154 Unless otherwise noted, all Scripture quotations are from the Holy Bible, New King James Version. Copyright 1979, 1980, 1982 by Thomas Nelson, Nashville, Tennessee. All rights reserved.
155 Martyn Lloyd-Jones, Studies in the Sermon on the Mount (Grand Rapid, Michigan: Eerdmans Publishers, 1971), Vol. 1, pp. 73-74.
156 John Piper, "Blessed Are Those Who Hunger and Thirst for Righteousness," (Desiring God Ministries, 1986),
Related Topics: Basics for Christians, Sanctification


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The New Orleans Hornets announced today that they have signed nine free agents (Brian Butch, Justin Dentmon, Jerome Dyson, Moses Ehambe, Carldell Johnson, Trey Johnson, DaJuan Summers, Lance Thomas and Terrico White). Per team policy, terms of the contracts were not released. The addition of the players puts the training camp roster at 15 thus far.
Butch (6-11, 240) sat out the 2010-11 season with a knee injury sustained last summer as a member of the Denver Nuggets. Butch has NBA experience with the Memphis Grizzlies summer league team and the Boston Celtics veteran minicamp, but has never appeared in a game. The Wisconsin product has played professionally in Greece, Spain, China and Germany during his career. During the 2009 season, he played for the Bakersfield Jam averaging 17.7 points and 11.9 rebounds earning a spot on the D-League Western Conference All-Star Team where he was named MVP.
Dentmon (5-11, 185) played in 50 games (35 starts) for the Texas Legends of the NBA D-League last season averaging 19.1 points, 4.0 assists and 3.5 rebounds. The University of Washington product was selected as a member of the 2011 USA Men's Basketball team that took home a Bronze medal in the Pan American Games this fall.
Dyson (6-3, 180) has appeared in six games (all starts) for the Tulsa 66ers of the NBA D-League this season averaging 19.7 points, 3.3 assists and 3.0 rebounds. During the 2010-11 season with the 66ers, the UCONN product played in 47 games (10 starts) averaging 15.5 points, 3.1 rebounds and 2.3 assists.
Ehamber (6-6, 215) has played in 125 career games in the NBA D-League over four seasons with Tulsa, Iowa and Austin. This season, the Oral Roberts product has averaged 21.5 points and 4.7 rebounds in six games (all starts). Ehamber finished last season with the Toros, averaging 10.2 points and 2.1 rebounds in 10 games.
Trey Johnson (6-5, 218) has played in 12 games over three seasons in the NBA for the Cleveland Cavaliers, Toronto Raptors and the Los Angeles Lakers with averages of 3.2 points and 0.9 assists. He appeared in three playoff games for the Lakers in the 2011 NBA Playoffs, averaging 1.0 points and 1.3 rebounds. In 10 preseason games with the Hornets and Lakers, the Jackson State product averaged 3.4 points and 1.5 rebounds. He has spent the majority of his professional career with the Bakersfield Jam of the NBA D-League. In 114 career games (92 starts) with the Jam, Johnson has averaged 20.7 points, 3.8 rebounds and 4.7 assists.
Carldell Johnson (5-10, 180) has appeared in 195 career games (102 starts) with the Austin Toros of the NBA D-League since 2007, averaging 8.0 points and 4.4 assists. In four games this season with Austin, he is averaging 14.8 points and 4.8 assists. The New Orleans native appeared in 46 games (all starts) for the Toros last season, averaging 12.3 points and a career-high 6.0 assists.
Summers (6-8, 240) was drafted in the second round of the 2009 NBA Draft (35th overall) by the Detroit Pistons. In 66 career games (one start) he has averages of 3.2 points and 1.0 rebounds in 9.2 minutes with Detroit. The Georgetown product signed with Montepaschi Siena in Italy in July of 2011, but parted ways with the team in October after averaging 4.0 points in four games with the team.
Thomas (6-8, 225) played for the Austin Toros of the NBA D-League the last two seasons. The Duke product averaged 17.3 points and 10.3 rebounds in four games this season for Austin. In the 2010-11 season, he averaged 12.6 points and 5.5 rebounds in 46 games.
White (6-5, 213) was drafted in the second round (36th overall) of the 2010 NBA Draft by the Detroit Pistons. In his first preseason appearance, White fractured his right foot and missed the remainder of his rookie season. The Ole Miss product averaged 15.1 points and 4.0 rebounds in 35 games (34 starts) his sophomore season in Oxford before declaring for the NBA Draft.


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Washington, DC – Davey Johnson will return as the Washington Nationals' manager for one final season after he and the club formally agreed to terms on a contract for 2013.
Johnson, who will turn 70 years old in January, will move into a consultant role with the organization following the completion of this upcoming season.
The veteran skipper piloted the Nationals to a major league-best 98 regular- season victories and a surprise National League East title in 2012, marking the franchise's first postseason appearance since the Montreal Expos reached the NLCS in 1981.
Johnson's contract expired following the World Series, and it was uncertain as to whether the NL Manager of the Year finalist would come back or opt for retirement.
Since taking over the Nationals during June of the 2011 season, Johnson has compiled a 138-107 overall record.
The 2012 Nationals became the fourth team Johnson has guided to the playoffs in a distinguished 16-year managerial career highlighted by his leading the 1986 New York Mets to a World Series title. Johnson was also named the 1997 AL Manager of the Year after directing the Baltimore Orioles to a 98-64 record and an ALCS appearance that season.
Johnson, who also steered Cincinnati to back-to-back postseason trips in 1994 and 1995, sports a 1,286-995 lifetime mark in stops with the Mets, Reds, Orioles, Los Angeles Dodgers and Nationals.


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Notice Number: NOT-OD-08-003
Key Dates
Release Date: October 18, 2007
Issued by
National Center for Environmental Health, Centers for Disease Control and Prevention (NCEH/CDC) http://www.cdc.gov/nceh/
This Notice is to inform potential applicants that the National Center for Environmental Health (NCEH) is joining the Parent Small Business Innovation Research (SBIR) Funding Opportunity Announcement (FOA), PA-07-280. Accordingly, applications on research topics within the mission of the NCEH can be submitted for the December 05, 2007 receipt date (January 8, 2008 for AIDS and AIDS-related applications). Note: CDC participates only in the SBIR program; it does not participate in the STTR program.
NCEH Program Description and Research Topics
The National Center for Environmental Health (NCEH) plans, directs, and coordinates a national program to maintain and improve the health of the American people by promoting a healthy environment and by preventing premature death and avoidable illness and disability caused by non-infectious, non-occupational environmental and related factors. The main activities of NCEH is to provide national leadership, through science and service in prevention programs, global health, and the use of human genetic knowledge, and tests.
Examples of potential areas of research pertinent to NCEH's participation in PA-07-280 include, but are not limited to, those identified below:
A. Environmental Health/Anti-Chemical Terrorism Rapid Field Tests for Human Exposure. There is a need to develop rapid, reliable, field rugged methods for detection and quantitative estimation of human exposure to environmental contaminants and toxic chemical-based weapons of mass destruction or terrorism. Such methods must be able to sense the presence or absence of such substances quickly and reliably, and provide estimations of concentration in human urine, saliva, breath, blood, or transpired through the skin. Minimums of false positives and false negatives are important for such technology to avoid wasting resources and missing actual exposures.
B. Detection of Human Exposure to Aflatoxins and Other Mycotoxins from Food or as Chemical Warfare or Terrorism Agents. Aflatoxins and other mycotoxins are products that naturally occur from fungi on grains and other food materials. They are produced at harmful levels under certain weather conditions or during improper storage. They have the potential to be weaponized as chemical warfare or terrorism agents. There is a need to develop analytical methods for detection of these compounds in urine, saliva, or blood in the field to support epidemiologic investigations or under battlefield conditions. Methods/ instruments must reliably detect and quantify human exposure to these agents, with limits of detection consistent with background levels in populations as well as levels in exposed persons.
C. Rapid Field Tests or Continuous Monitors for Arsenic in Drinking Water. Drinking water with toxic levels of naturally occurring arsenic obtained from shallow wells is a serious problem in many parts of the world. Recently, this problem has become especially acute in rural areas of the under-developed world because of efforts to improve drinking water sources that unfortunately did not fully consider natural sources of arsenic. The solution requires deep wells, or water treatment at the point of use. However, because of uncertainty about the level of arsenic in water from these improved sources, and because of the need to give attention to the most heavily contaminated existing shallow wells first, there is a need to develop rapid, reliable, and cost effective tests or monitors for water arsenic.
D. Rapid Field Tests for Iodine Levels in Urine and Salt. Iodine deficiency is a global problem affecting millions of people, leading to reduced population IQ, cretinism, goiter, and contributing to thyroid cancer. To facilitate efforts to eliminate this problem, rapid, simple, and inexpensive tests are needed that can determine the concentration of iodine in urine for population screening work, and that can determine the concentration of iodine in salt samples for quality control purposes in iodized salt production. While field tests for iodized salt have been developed in recent years, they have proven to be inaccurate and unreliable. Tests for urinary iodine typically have required complicated laboratory procedures. Simple, reliable measures for field use would be a great help.
E. Coronary Heart Disease. The development of a laboratory technology to standardize and improve the quality and reliability of laboratory tests for cholesterol and other metabolically related lipids and lipoproteins that are known risk factors associated with coronary heart disease is an area that needs improvement of diagnostic techniques. Specifically, the contractor should develop and characterize improved serum reference materials that can be used by NCEH to standardize laboratories that conduct epidemiological and lipid research and clinical trials into the causes and prevention of coronary heart disease.
F. Rapid Field Tests for Vitamin A Status. There is a need for the development of rapid, rugged field portable, and economical techniques for determining vitamin A status in finger stick or earlobe blood samples collected by microcapillary techniques or on filter paper. Methods may be based on fluorescence, optical density, or any other technique which reliably estimates vitamin A status in humans, but it should correlate to widely accepted "reference" methods such as high performance liquid chromatography (HPLC). Such methods would be highly valuable in global efforts to eliminate vitamin A deficiency, a high priority for WHO, UNICEF, USAID, and many other international agencies. Vitamin A deficiency is a devastating problem especially in developing countries where it contributes significantly to childhood morbidity and mortality, and is a leading cause of blindness in many parts of the world.
G. Rapid and Reliable Field Tests for Serum Ferritin and Transferrin Receptor. Iron deficiency and iron deficiency anemia are serious problems throughout the developing world and in many high-risk groups in developed countries, including the United States. These problems negatively impact societies by reducing work capacity, impairing mental development and learning, and increasing morbidity and mortality, especially in women of child bearing age and young children. There is a need to develop reliable, easy to operate, and cost effective devices for screening for serum ferritin, and if possible for serum transferring receptor in populations and for managing individuals receiving iron intervention treatments. These devices would have to operate properly in climatic conditions that are not always regulated. Portable devices would be desirable. The use of blood collected through a minimally invasive technique would be preferred.
H. Development of Stable Isotope Labeled Proteins for Quantitation of Protein Biomarkers. Improving the accuracy of measurements of protein levels in humans is an important step toward a better understanding of many diseases. The choice of standards is usually the key for the precision, reproducibility and accuracy of measurements of different compounds. Isotope dilution mass spectrometry is widely used for the quantitation of small molecules in biological specimens. It improves the measurements of low concentrations of chemicals and biomarkers in such samples so that concentrations can be correlated to internal dose. The use of isotope dilution mass spectrometry for the analysis of proteins is less developed due to the difficulties associated with the synthesis of the isotopically labeled proteins used as internal standards in this technique. In order to fulfill this gap, high purity proteins (>95% purity) are needed in which stable isotopes are incorporated into the protein. 13C and 15N are to be incorporated as labeling isotopes instead of 2H or 18O because the later can sometimes be exchanged during sample processing. Enough number of labels should be introduced in the protein so they can be analyzed with a triple quadrupole mass spectrometer and produce meaningful results. We would like to develop a new project for producing high purity labeled hemoglobin, albumin and insulin, which will be used as standards for the quantitation of protein biomarkers.
I. Improved Tests for Zinc Status and Zinc Body Stores in Humans. The essential element zinc has been shown to be extremely important in human health. Recently it has been especially important as a cofactor in efforts to combat iron deficiency and vitamin A deficiency in the developing world. There is a need to develop simple, reliable, easy to operate, and cost effective methods or instruments for screening for zinc deficiency in populations and for managing individuals receiving intervention treatments. There is also a need for improved approaches to assessing zinc body stores.
J. Improving Assessment of Children's Exposure to Toxic Substances. Children tend to be more susceptible to toxic substances than adults because of a variety of differences related to physical and functional characteristics. It is imperative that exposure of children to toxic substances be minimized or eliminated since exposures could result in subtle effects upon children's growth, maturation, and health. Children are generally at greater risk than adults for exposure to environmental pollutants from inhalation because they have a higher respiratory rate; from dermal exposure because they have more exposed surface area; and from ingestion because they have a tendency to play in and eat dirt. In order to address children's exposures, the following rapid response technology is needed:
1. Development of an "environmental sensor" that would detect concentration levels of volatile organic compounds (VOCs) and particulates at threshold levels that would be harmful to small children.
2. Development of a "soil tester" that would determine the concentration level of various trace metals and other environmental pollutants that might concentrate in soil, where children are likely to play.
Inquiries regarding this Notice should be directed to:
SBIR Grants Info
Office of Public Health Research
Office of the Chief Science Officer
Centers for Disease Control and Prevention
Phone: 404-639-4621TTY: 301-451-5936
1600 Clifton Road NE, MS D-72
Atlanta, GA 30333
Telephone: 404-639-4641
Fax: 404-639-4903
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A Trail Of Feathers © 2013
One woman's true story about love, death, murder, political power, and consciousness, A Trail of Feathers follows the author's shamanic journey from despair to self-discovery and spiritual awakening. A young woman of privilege marries into one of Kentucky's most famous families. Her fairly charmed life begins to quaver when she encounters love, death, murder, political power, and deception until ultimately transforming herself—and her life—on a shamanic journey of self-discovery. Tracey L. Damron's spiritual awakening is more than an extraordinary expose of the behind-the-scenes workings of a very public family, but it is a very intimate, gentle look at one woman's slow process of awakening.
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Tracey Damron lives part- time in Pikeville, Kentucky at Spring Branch Farm. She spends time with her horse Magick and cats, Moonman and Baby. Spring Branch Farm hosts horse shows annually from May thru September. Tracey is an active participant in the horse shows and welcomes all to attend. Her favorite pastime is taking long walks in the mountains where she convenes with nature and feels closest to Creator. Tracey lives in a 200 year old farm house that she has renovated to accommodate spiritual retreats, practices as a medicine woman, and enjoying life.
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Making the Most Out of Visits to Elderly Parents
These days, it's not uncommon for parents and children to be separated from one another by tens — or even hundreds — of miles. When aging starts to take a toll on our parents' well-being, this can be a problem. Very few of us can uproot our lives to move closer to mom and dad. That means that it's important to make the most of visits when they happen.
"Visits can make a big difference when elderly parents and adult children are separated by long distances," says Larry Meigs, President and CEO of Visiting Angels, a nationwide network of elderly care providers. "Whether you're using that time to take care of tough housekeeping jobs, to check up on your mom or dad's well-being, or simply to have a nice meal and some pleasant conversation, there's a lot that you can pack into a day or an afternoon."
If you're starting to worry about your mom or dad's well-being and want to make the most out of the time you spend together, here are some tips for what you can accomplish on your next visit.
Tough Tasks Around the Home
As we grow older, it becomes more and more difficult to accomplish important tasks around the home. Physically draining jobs, like shoveling the driveway or clearing the gutters, can be too much for seniors to handle. In other cases, poor eyesight or physical limitations mean that seniors miss signs of wear or damage around the home. And sometimes, seniors simply don't have the energy they need to take care of day-to-day tasks.
When visiting elderly parents, one of the best things you can do is to volunteer for tough jobs around the house. Before visiting, ask your parent if there are any jobs that they need to have done. This way, you can plan your visit around these jobs and bring any tools, equipment, or materials you might need.
Of course, your mom or dad won't always tell you when they need tasks performed. Sometimes, they might be embarrassed to ask for help. Other times, they may not realize that work needs to be done. Because of this, it can be helpful to do a housekeeping check of your parent's house early in your visit. Use this opportunity to check for signs of wear or damage, inspect areas that require seasonal maintenance, and look for small jobs that need to done about the home.
Performing a Wellness Check
One important part of a visit to an elderly parent is checking in on his or her well-being. Many seniors find it hard to admit when they are starting to have trouble taking care of themselves, and so it is often up to adult children to notice signs of deteriorating well-being.
Checking in on a parent's wellness starts with asking them questions about their physical, mental, and emotional well-being. While it's best to ask these questions in person when possible, you can often ask them by phone during daily or weekly calls.
Of course, not all senior are forthcoming about day-to-day challenges and problems with their health. It's important, then, to check for signs of health problems in your parent when you have the chance. Sometimes, these signs will be evident in your parent — such as trouble getting up from their seat, a lack of energy, or creeping forgetfulness. Other times, indications can be found in their living conditions — such as signs of hoarding, forgetting to bathe, or a lack of housekeeping.
When it becomes clear that a loved one may be struggling with the activities of day-to-day life, you may consider the help of an in-home caregiver. Many home care agencies, including your loved one's local Visiting Angels office, will be happy to coordinate a care plan via long distance.
Taking Time for Each Other
Sometimes, it can be easy to get carried away worrying about your mom and dad. You might spend your whole visit fretting over jobs that need to be done around the home or about signs that your parent's health isn't what it used to be.
While it is only natural to worry over those we care about, it's important not to lose sight of what makes visits with our loved ones so special. If you live far enough away from your parents that you can only see them once a month (or even less frequently), the time you spend together will be even more valuable. So make sure that you set aside quality time every visit, whether sharing a homecooked meal, playing a game of cards, or simply taking the time to have the kinds of conversations you don't have over the phone.
And remember that if visits every now and again don't seem to be enough for your loved one, help is available. To find out how your local Visiting Angels can help, learn more about our long distance caregiving services today.


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We know that you care how information about you is collected, used and shared. This Privacy Policy describes how we collect, use and share information when you use our Services. The terms "we," "us," or "our" mean The Kolter Group, LLC. The term "Services," means, collectively, various websites, applications, email notifications and other mediums, or portions of such mediums, through which you have accessed this Privacy Policy. By accessing or using our Services, you consent to the collection, transfer, manipulation, storage, disclosure and other uses of Your Information (collectively, "Use of Your Information") as described in this Privacy Policy.
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We might receive or collect several types of information about you, such as your name, address, telephone number, e-mail address, or other information that you may submit to Kolter via the "Contact Us" page or via a forum. The following are other situations in which you may provide Your Information to us:
We may collect information about you from sources other than you, such as from social media websites (i.e., Facebook, LinkedIn, Twitter or others), blogs, other users and our business partners.
We may collect, receive and store information regarding your general use of our Services (such as details of how and when you used our Services, interactions with our Services, log in information, resources that you access, your Internet protocol address, your browser type, and your device type), as well as your preferences.
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We, and third parties use various technologies to collect and store information when you use our Services, including sending cookies, pixel tags or other anonymous identifiers to your device. "Cookies" are pieces of data stored on our computer, mobile phone or other device. A "pixel tag" is a type of technology placed within a website or email for the purpose of tracking activity, which is often used in combination with cookies. Other "anonymous identifiers" are random strings of characters used for the same purposes as cookies, such as with mobile devices where cookie technology is not available. These technologies help us know that you are logged on, provide you with features based on your preferences, understand when you are interacting with our Services, and compile other information regarding use of our Services.
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Major-General Kristin Lund signing the hand-over document with outgoing Major General Chao Liu at the UN peacekeeping force in Cyprus headquarters. Photo: UNFICYP
11 August 2014 – Major General Kristin Lund today officially assumed her duties as Force Commander of the United Nations peacekeeping force in Cyprus where the top UN official, Lisa Buttenheim, is also a woman. That UN operation is now the first in the world to have a dual female leadership.
At a brief ceremony held in the UN Protected Area in Nicosia, Special Representative of the Secretary-General, Ms. Buttenheim, thanked Major General Lund's predecessor, Major General Chao Liu, a Chinese national who served from February 2011. The Special Representative paid tribute to his "dedication, professionalism and leadership which greater contributed to United Nations efforts on the island."
The Security Council established the UN Peacekeeping Force in Cyprus (UNFICYP), which marked its 50th anniversary in March, in 1964 to contribute to a return to normal conditions following violence and bloodshed between the Greek Cypriot and Turkish Cypriot communities.
In Cyprus, Major General Lund is commanding a force which over the years has rotated through more than 150,000 troops. UN troops supervise the de facto cease fire lines established in 1974, and maintain control over the buffer zone dividing the island. Despite the general calm, UNFICYP records on average about 1,000 incidents in the buffer zone every year.
"It's hard to believe there is a place where you can go and have a beautiful day vacation, [but] has mine fields that are not cleared yet," Major General Lund had told the UN News Centre back in May. At that time, the Major General said she would prepare for her position by analyzing the Mission mandate to see what type of activities she could do in support of the Mission and SRSG Buttenheim.
In addition to its military activities, UNFICYP also undertakes humanitarian activities and supports the good offices mission of the Secretary-General, according to its website.
"When you approach a challenge in a country, such as Cyprus, it's important also that you represent – because there are so many men force commanders – the other 50 per cent of the population in the world," Major General Lund had said.
"I think it's very important that the UN took this step to appoint a female force commander and I hope that I can be a role model for other female officers that see that it's possible."
The Norwegian Major General has had a distinguished military career, according to Secretary-General Ban Ki-moon's spokesperson, with over 34 years of military command and staff experience at national and international levels.
"The first time you are out is often, in a way, what sits for a long time in your mind," the Major General said about her deployment to Lebanon with the UN Interim Force in Lebanon (UNIFIL) in 1986 as a transport officer.
"I was on a vehicle where we had 50 calibre, we had a machine gun and I was sitting behind the machine gun," she said describing an escort mission to pick up new soldiers. After shooting broke out, the vehicle took an alternative route and ended up in an area where it was not supposed to be.
"The way to handle it was actually through communication, through building trust at the check points. And I think that was the first time I realized why it is so important for the UN to always use minimal force and as a last resort," she continued.
Her deployment in the Balkans, where between 1992 and 1993 she served with the UN Protection Force (UNPROFOR) in Bosnia and later with the NATO-led force, was what "formed me as a leader because you have to play like an orchestra" [to cope] with the various military components and the people involved in the conflict.
"You learn how important the mandate is," she said, referring to the responsibilities tasked to the Mission by the 15-member UN Security Council. "You see the importance of not taking sides."
Bosnia was also the first deployment where the Major General experienced real violence.
"It's not normal that you see people get killed. You get used to seeing scenes that you, as a military, in a way, prepare for, but you don't actually hope to get involved. But there you saw the whole spectra," she recalled in her interview with the UN News Centre.
Major General Lund also served in the Middle East during the first Gulf War in 1991 and in Afghanistan with the International Security Assistance Force (ISAF) from 2003 to 2004.
Ms. Lund rejoins the Organization as the UN Department of Peacekeeping is spearheading a modernization campaign in its missions "to do more with less," at the request of the Secretary-General and the resource-contributing Member States.
"Communication is vital," said Maj Gen Lund, who led the 56,000-strong Norwegian Home Guard during its modernization. "When you are changing a huge organization, everyone needs to know the end stage, where are we going, because if you are [making] changes and you don't have all the layers with you, it will take a very long time."
She was appointed Norway's first female General in 2009, having taken deputy command of the country's armed forces in 2007. Her most recent position was head of Veteran Affairs on the Norwegian Defence Staff.
A motorcycle aficionado, Ms. Lund has decided against taking her beloved Harley to Cyprus.
"I'm quite into Harley-Davidson, that's my favourite, but I don't think I will take a bike. I will see if I can borrow or buy a bike there because [mine is] a collector's item."


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I'll admit that I am kind of rolling multiple questions in to one here so please forgive me and try not to knock me for it.
I am new to Mac but I'm trying to port one of my Java applications to OS X. On Windows, it uses the hard drive serial number for something and I'm looking to do equivalent in Mac using the Terminal!
The close thing I can find is the volume UUID using diskutil info ...
, which is fine (as long as this will always stay the same?): so my main question is which volume I should use, seeing as though three appear when I type diskutil list
? Obviously it needs to have a UUID, but I would also like to use the volume that is least likely to change, which would seem to be the one with the operating system on to me!
So I would like to know which volume is the safest for me to use for this purpose, and if it varies on different computers - how to find it!
Thanks in advance